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Drug overdose deaths in pregnancy or the postpartum period increased sharply in the U.S. in recent years, with the rise most pronounced at the start of the COVID-19 pandemic in 2020, researchers reported.

From 2017 to 2020, overdose deaths in this population rose from 6.56 to 11.85 per 100,000 individuals, representing an 81% increase, according to Emilie Bruzelius, MPH, and Silvia S. Martins, MD, PhD, both of Columbia University Mailman School of Public Health in New York City, who reported their findings in .

By comparison, overdose deaths among non-pregnant females of reproductive age increased from 14.37 to 19.76 per 100,000, a relative increase of 38%.

Among the 7,642 pregnancy-associated deaths identified in the restricted National Vital Statistics System mortality files during the study period, a total of 1,249 were overdose-related, with a full one-third of the overdose-related deaths occurring in 2020.

"Pregnant and postpartum people are known to face barriers to accessing drug treatment and harm reduction services, that when compounded by pandemic-associated stressors, healthcare shutdowns, and an increasingly volatile unregulated drug supply, may have increased fatal overdose risk," Bruzelius explained in a .

Deaths involving benzodiazepines, heroin, and prescription opioids in pregnant or postpartum individuals were mostly stable from 2017 to 2020, Bruzelius and Martins found. But there was a large increase in deaths involving fentanyl and other synthetics and psychostimulants, such as methamphetamine and cocaine (5.73 to 9.47 per 100,000).

"Enhanced strategies supporting substance use prevention, treatment, and harm reduction efforts among pregnant and postpartum people are critical and much needed," Martins said. "We expect new and improved approaches will help address the concerning trends we are seeing."

Pregnancy-associated deaths were identified based on pregnancy-related ICD-10 codes, as well death certificates, which identify whether a person was pregnant at the time of death, within 42 days of death (early postpartum), or within 43 to 365 days of death (late postpartum). Drug overdoses were also identified using ICD-10 codes. The comparison of reproductive age individuals (15 to 44) included those listed as female on their death certificate but not identified as pregnant or postpartum.

The cumulative overdose mortality rate among the pregnant or postpartum group was 8.35 per 100,000 from 2017 to 2020. A higher cumulative rate was observed among those in the late-postpartum period versus those who were pregnant at the time of death or in the early-postpartum period.

• Late postpartum: 3.95 per 100,000
• Pregnant: 2.99 per 100,000
• Early postpartum: 1.39 per 100,000

The authors emphasized the need for more accurate data collection when it comes to deaths among pregnant and postpartum people, and called for more awareness about the challenges facing this patient population.

Jacob S. Ballon, MD, MPH, of Stanford University in California, noted that the study authors did not provide explanations for why the overdose-related death rate rose sharper among the pregnant and postpartum group during the study period, but said it will likely be the basis for further research.

"[It's] an interesting signal," said Ballon, who was not involved with the study. "But now what do we do with that to explain it or make some sense of it?"

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